Characterization and localization of prostaglandin E1 receptors in rat liver plasma membranes

Methodology for measurement and characterization of prostaglandin binding to membranes has been developed. The binding assay was used to study the presence of prostaglandin receptors in high purified cell fractions derived from rat liver. High affinity binding receptors which have a saturation value of 1.0 pmole/mg protein and a dissociation constant of 1.2 nM were found exclusively in the plasma membrane. High affinity receptors were not found in cell fractions containing nuclei, rough microsomes. Golgi complex or mitochondria. The binding by other prostaglandins was competitive with prostaglandin E₁. Competitive binding studies were used to obtain dissociation constants for prostaglandins F_1α, F_2α, B₁, B₂, A₁, A₂, and 15-keto prostaglandin E₂ which were 1100, 100, 300, 180, 16. 16 and 700 nM, respectively. Eicosa-5.8.11.19-tetraynoic acid, an inhibitor of prostaglandin synthesis did not bind appreciably to the prostaglandin E receptor, whereas two prostaglandin analogues, which have high physiological activity compete effectively with prostaglandin E₁ for the receptor. Thus, the binding receptor for the E-type prostaglandins is highly specific both with respect to cell localization as well as the type of substrate. Numerical routines for the fitting of the data and a procedure for the determination of the specific activity of the labelled prostaglandin are provided.     

Specific prostaglandine E1 and A1 binding sites in rat a dipocyte plasma membranes

Rat adipocyte plasma membranes sacs have been shown to be a sensitive and specific system for studying prostaglandin binding. The binding of prostaglandin E₁ and prostaglandin A₁ increases linearly with increasing protein concentration, and is a temperature-sensitive process. Prostaglandin E₁ binding is not ion dependent, but is enhanced by GTP. Prostaglandin A₁ binding is stimulated by ions, but is not affected by GTP.Discrete binding sites for prostaglandin E₁ and A₁ were found. Scatchard plot analysis showed that the binding of both prostaglandins was biphasic, indicating two types of binding sites. Prostaglandin E₁ had association constants of 4.9 · 10⁹ 1/mole and 4 · 10⁸ 1/mole, while the prostaglandin A₁ association constants and binding capacities varied according to the ionic composition of the buffer. In Tris-HCl buffer, the prostaglandin A₁ association constants were 8.3 · 10⁸ 1/mole and 5.7 · 10⁷ 1/mole, while in the Krebs—Ringer Tris buffer, the results were 1.2 · 10⁹ 1/mole and 8.6 · 10⁶ 1/mole.Some cross-reactivity between prostaglandin E₁ and A₁ was found for their respective binding sites. Using Scatchard plot analysis, it was found that a 10-fold excess of prostaglandin E₁ inhibited prostaglandin A₁ binding by 1–20% depending upon the concentration of prostaglandin A₁ used. Prostaglandin E₁ competes primarily for the A prostaglandin high-affinity binding site. Similar Scatchard analysis using a 20-fold excess of prostaglandin A₁ inhibited prostaglandin E₁ binding by 10–40%. Prostaglandin A₁ was found to compete primarily for the E prostaglandin low-affinity receptor.All of the bound [³H]prostaglandin E₁, but only 64% of the bound [³H]-prostaglandin A₁ can be recovered unmetabolized from the fat cell membrane. There is no non-specific binding of prostaglandin E₁, but 10–15% of prostaglandin A₁ binding to adipocyte membranes is non-specific. Using a parallel line assay to measure relative affinities for the E binding site, prostaglandin E₁ > prostaglandin A₂ > prostaglandin F_2α. Prostaglandin E₂ and 16,16-dimethyl prostaglandin E₂ were equipotent with prostaglandin E₁, while other prostaglandins had lower relative affinities. 7-Oxa-13-prostynoic acid does not appear to antagonize prostaglandin activity in adipocytes at the level of the receptor.     

The treatment of the hepatorenal syndrome with intra-renal administration of prostaglandin E1

Three patients with the hepatorenal syndrome were treated with prostaglandin E₁ administered through a selective renal arterial catheter. Prostaglandin E₁ was given in progressively increasing doses (2 to 100 ng/kg/min) over a 60-minute period. Control plasma prostaglandin E levels were elevated in all three patients, 0.98, 0.91, and 0.83 ng/ml, respectively. At the end of the infusion, plasma prostaglandin E levels had risen to 10.4, 2.63, and 10.3 ng/ml in the three patients respectively. Plasma renin activity increased during the course of the infusion in two of the patients. The plasma aldosterone concentration did not change during the prostaglandin E₁ infusion. Intrarenal prostaglandin E₁ failed to increase urine volume or urinary sodium concentration in three patients with the hepatorenal syndrome.     

Mechanism of increased renal prostaglandin E2 in uranyl nitrate-induced acute renal failure

We have previously demonstrated that decreased cortical prostaglandin metabolism can contribute significantly to an increase in renal tissue levels and activity of prostaglandin E₂ in bilateral ureteral obstruction, a model of acute renal failure. In the present study, we have further investigated whether alterations in prostaglandin metabolism can occur in a nephrotoxic model of acute renal failure. Prostaglandin synthesis, prostaglandin E₂ metabolism (measured as both prostaglandin E₂-9-ketoreductase and prostaglandin E₂-15-hydroxydehydrogenase activity), and tissue concentration of prostaglandin E₂ were determined in rabbit kidneys following an intravenous administration of uranyl nitrate (5 mg/kg). No changes in the rates of cortical microsomal prostaglandin E₂ and prostaglandin F_2α synthesis were noted at the end of 1 and 3 days, while medullary synthesis of prostaglandin E₂ fell by 47% after 1 day and 43% after 3 days. Cortical cytosolic prostaglandin E₂-9-ketoreductase activity was found to be decreased by 36% and 76% after 1 and 3 days respectively. No significant changes were noted in cortical cytosolic prostaglandin E₂-15-hydroxydehydrogenase activity after 3 days. Cortical tissue levels of prostaglandin E₂ increased by 500% at the end of 3 days. These data demonstrate that in nephrotoxic acute renal failure, decreased prostaglandin metabolism (i.e., prostaglandin E₂-9-ketoreductase activity) can result in increased tissue levels of prostaglandin E₂ in the absence of increased prostaglandin synthesis and suggest that alterations in prostaglandin metabolism may be an important regulator of prostaglandin activity in acute renal failure.     

The influence of prostaglandins on sperm motility

Prostaglandin E₂ and F_2α were measured in ejaculates from 10 fertile and 55 infertile men. Prostaglandin F_2α was negatively correlated with motility (r=0.77; p<0.01) in normal men. In patients with disturbed fertility, prostaglandin F_2α was always higher than in the controls, while prostaglandin E₂ was elevated only in patients with persisting varicocele and in those with very low sperm counts and severely impaired motility. There was neither synthesis of prostaglandins in spermatozoa nor were binding sites for prostaglandin E₂ and F_2α detectable. Inactivation of seminal prostaglandins by incubation with prostaglandin 15-hydroxydehydrogenase resulted in a dramatic fall in motility. The results suggest that prostaglandin F_2α act on motility, but the action is not mediated by receptors.     

Prostaglandin E1 binding and adenylate cyclase activation in normal and transformed fibroblasts

The binding of [³H]prostaglandin E₁ to membranes of clones of normal rat kidney fibroblasts (NRK cells) has been measured. Cell lines that responded to prostaglandin E₁, such as NRK and NRK transformed with Schmitt-Ruppin strain of Rous sarcoma virus (SR-NRK cells), have a high affinity prostaglandin E₁ binding site. Murine-sarcoma-virus-transformed lines of NRK cells are unresponsive to prostaglandin E₁ and have reduced prostaglandin E₁ binding. Exposure of cells to prostaglandin E₁ results both in decreases prostaglandin E₁ responsiveness and reduced prostaglandin E₁ binding.Activation of adenylate cyclase is correlated to binding of prostaglandin E₁ to receptors in both NRK and SR-NRK cell membranes. Mathematical models suggest that GTP decreases the affinity of hormone for its receptor while increasing the catalytic efficiency of adenylate cyclase, and that aggregates of occupied receptors may play an important role in the activation of adenylate cyclase.     

Prostaglandin stimulation of ovarian ornithine decarboxylase in vitro.

Prostaglandins E₁ and E₂ caused a 5–10 fold stimulation of ornithine decarboxylase activity in granulosa cells isolated from porcine ovarian follicles. The minimally effective concentration of prostaglandin E₂ was 10 ng/ml and the plateau of activity was reached at 500 ng/ml. Prostaglandin F_2α was ineffective. 1-Methyl,3-isobutyl-xanthine, a phosphodiesterase inhibitor, potentiated the effect of both submaximal and maximal effective doses of prostaglandin E₂, suggesting that the effect of prostaglandin E₂ is mediated by cAMP. The effect of prostaglandin E₂ was similar to that of luteinizing hormone and a cAMP analogue, 8-Bromo-cAMP.     

Multiple effects of guanine nucleotides on human platelet adenylate cyclase

We report that the adenylate cyclase system in human platelets is subject to multiple regulation by guanine nucleotides. Previously it has been reported that GTP is either required for or has little effect on the response of the enzyme to prostaglandin E₁. We have found that when platelet lysates were prepared in the presence of 5 mM EDTA, GTP lowered the basal and prostaglandin E₁-stimulated adenylate cyclase activity when the enzyme was assayed in the presence of Mg²⁺. The basal and prostaglandin E₁-stimulated adenylate cyclase activities were also increased by washing, which presumably removes endogenous GTP. The analog, guanyl-5′-yl-imidodiphosphate mimics the inhibitory effect of GTP on prostaglandin E₁-stimulated adenylate cyclase activity but it stimulates basal enzyme activity. The onset of the inhibitory effect of GTP on the adenylate cyclase system is rapid (1 min) and is maintained at a constant rate during incubation for 10 min. GTP and guanyl-5′-yl-imidodiphosphate were noncompetitive inhibitors of prostaglandin E₁. An increase in the concentration of Mg²⁺ gradually reduces the effect of GTP while having little influence on the effect of guanyl-5′-yl-imidodiphosphate. Neither the substrate concentration nor the pH (7.2–8.5) is related to the inhibitory effect of guanine nucleotides. The inhibition by nucleotides was found to show a specificity for purine nucleotides with the order of potency being guanyl-5′-yl-imidodiphosphate > dGTP > GTP > ITP > XTP > CTP > TTP. The inhibitory effect of GTP is reversible while the effect of guanyl-5′-yl-imidodiphosphate is irreversible. The GTP inhibitory effect was abolished by preparing the lysates in the presence of Ca²⁺. However, the inhibitory effect of guanyl-5′-yl-imidodiphosphate persisted. Substitution of Mn²⁺ for Mg²⁺ in the assay medium resulted in a diminution of the inhibitory effect of GTP on basal activity and converted the inhibitory effect of GTP on prostaglandin E₁-stimulated activity to a stimulatory effect. At a lower concentration of Mn²⁺ (less than 2 mM) guanyl-5′-yl-imidodiphosphate inhibited prostaglandin E₁-stimulated adenylate cyclase activity, but at a higher concentration of Mn²⁺, it caused an increase in enzyme activity exceeding that occuring in the presence of prostaglandin E₁. In the presence of Mn²⁺, dGTP mimics the effect of GTP and is 50% as effective as GTP. Our data suggest that the inhibitory effect of GTP on prostaglandin E₁-stimulated adenylate cyclase is mainly due to its direct effect on the enzyme itself, whereas the stimulatory effect of GTP on prostaglandin E₁-stimulated adenylate cyclase is due to enhancement of the coupling between the prostaglandin E₁ receptor and adenylate cyclase. These studies also indicate that the method of preparation of platelet lysates can profoundly alter the nature of guanine nucleotide regulation of adenylate cyclase.     

Bone remodelling induced by physical stress is prostaglandin E2 mediated

In vitro cultured bone cells were found to be responsive to hormones and physical forces. A simple device has been developed which enables the direct application of physical forces to tissue culture dishes to which cells are firmly attached. The physical forces created a deformation of the dish. It was found that prostaglandin E₂ synthesis underwent a rapid increase, reaching a maximum after 20 min and then declined. Concurrent with the increase in prostaglandin E₂ was an increase in cyclic AMP production, having a maximum around 15 min. The increase in cyclic AMP was blocked by indomethacin, the prostaglandin E₂ synthesis inhibitor, indicating the dependence of cyclic AMP production on the de novo synthesis of prostaglandin E₂. Prostaglandin E₂ added to cells mimicked the effect of physical forces on the production of cyclic AMP. The increase in cyclic AMP resulted from an early rise in adenyl cyclase activity (within 5 min) and a later (10 min) increase in phosphodiesterase activity. The same physical forces also stimulatedthe incorporation of thymidine into DNA after 24 h. On addition of prostaglandin E₂ the increase in DNA synthesis was also mimicked. Pretreatment of the cells with indomethacin abolished the effect of physical forces on DNA synthesis.The results suggest a stimulus receptor mechanism for physical forces which, like hormonal effectors, are mediated by prostaglandins and stimulate cyclic AMP and DNA synthesis.We believe that physical forces stimulate bone remodelling through such a stimulus receptor system, mediated by prostaglandins.     

Prostaglandins and Glaucoma

Human aqueous humour was found to contain a substance which contracted the rat stomach strip. The mean activity was significantly higher in specimens from open angle glaucoma cases than in specimens from patients with cataract. The pharmacological and chromatographic properties of the active material were studied in aqueous humour obtained from cadavers; activity seemed to be due to prostaglandin E₁. These results suggest that prostaglandin E₁ may play some part in the aetiology of open angle glaucoma.     

Therapeutic Abortion by Intra-amniotic Injection of Prostaglandins

Intra-amniotic injection of either prostaglandin F₂α or prostaglandin E₂ was used in an attempt to induce therapeutic abortion in mid-pregnancy in 27 patients. Termination of pregnancy was successful in 11 out of 13 cases when prostaglandin E₂ alone was used, but in only 6 out of 14 cases when prostaglandin F₂α was used. A further eight patients aborted after additional intravenous oxytocin stimulation, but the combined procedures failed altogether in two patients who were initially given prostaglandin F₂α. The technique was simple, free from serious side effects, and reasonably effective when prostaglandin E₂ was used.     

Electron spin resonance detection of free radicals in the mercaptan-activation and UV-inactivation of neocarzinostatin

Differentiation of chick embryo myoblasts $\text{in}\text{,}\text{vitro}$ requires both cell-cell recognition and cell-cell fusion. Prostaglandin E₁ is known to play a role in controlling fusion, and a specific receptor has been postulated. We demonstrate two peaks of specific binding activity for prostaglandin E₁ during myoblast differentiation $\text{in}\text{,}\text{vitro}$: one at 36 hours and one at 44 hours of culture. The prostaglandin binding activity of both peaks is sensitive to the inhibitors of prostaglandin synthesis, indomethacin and aspirin, and to the antibiotic tunicamycin. The 36 hour peak of binding activity occurs at the same time as the process of cell-cell recognition (24–36 hours) and recognition and prostaglandin binding exhibit similar sensitivity to indomethacin, aspirin and tunicamycin.     

Prostaglandins and skin tumor promotion: inhibition of tumor promoter-induced ornithine decarboxylase activity in epidermis by inhibitors of prostaglandin synthesis.

Application of 12-O-tetradecanoylphorbol-13-acetate to mouse skin led to a dramatic induction of epidermal ornithine decarboxylase (EC 4.1.1.17; L-ornithine carboxy-lyase) activity. The degree of induction was remarkably depressed by prior treatment of skin with indomethacin, acetylsalicylic acid or flufenamic acid, inhibitors of prostaglandin synthesis. In contrast, dexamethasone, a steroidal anti-inflammatory drug, was ineffective. The inhibition of tumor promoter-induced ornithine decarboxylase activity by the non-steroidal anti-inflammatory drugs was completely counteracted by treatment with prostaglandin E₁ and E₂ but not with prostaglandin F_1α or F_2α.     

Prostaglandin E2 and muscle protein turnover inPseudomonas aeruginosa sepsis

Rats were injected intraperitoneally withPseudomonas aeruginosa (septic group) or sterile 0.9% NaCl (controls). Soleus muscles were excised 7 h later, and muscle prostaglandin E₂ release and tyrosine release were measured in vitro. Muscles of septic rats exhibited 226–326% higher release of prostaglandin E₂ and 54–84% higher net proteolysis than muscles of controls. Inclusion of aspirin or indomethacin in the incubation medium almost completely inhibited prostaglandin E₂ production, but had no effect on net proteolysis in muscles from either group. Inclusion of cycloheximide, a protein synthesis inhibitor, increased tyrosine release of control muscles by 42%, whereas no statistically significant increase was observed in muscles from infected rats. However, total proteolytic rate, indexed by tyrosine release in the presence of cycloheximide, was 22% higher in muscles of septic rats compared to that of control animals. Concomitantly, inclusion of cycloheximide inhibited prostaglandin E₂ release by muscles of infected rats by 91% and that of controls by 65%. It is concluded that (a) muscles of septic animals exhibit a pronounced stimulation of prostaglandin E₂ release and net proteolysis, combined with a small increase in total proteolytic rate, (b) the stimulation of net proteolysis is mainly due to inhibition of protein synthesis, (c) the increases in net and total proteolysis appear to be independent of prostaglandin E₂ production, (d) cycloheximide has a previously unrecognized inhibitory effect on muscle prostaglandin E₂ production.     

Induction of choline acetyltransferase in the neuroblastoma x glioma cell line NG108-15

The mechanism of the induction of choline acetyltransferase activity in the hybrid cell line NG108-15 was studied. Induction by cyclic AMP analogs, forskolin, and prostaglandin E₁ + theophylline was found to be rapid with an increase in choline acetyltransferase specific activity detectable within 8 hrs and maximal after 24 hrs. Immunoblot analysis was used to demonstrate that the increase in choline acetyltransferase specific activity induced by prostaglandin E₁ + theophylline was due to an increase in enzyme protein. Cycloheximide effectively blocked the induction of choline acetyltransferase by prostaglandin E₁ + theophylline. These results demonstrate that the induction of choline acetyltransferase activity involves the synthesis of new enzyme protein. Attempts to measure choline acetyltransferase turnover by blocking its synthesis with cycloheximide indicated that this enzyme is a relatively stable protein with a half-life of greater than 24 hrs.     

Prostaglandin E2, prostaglandin E1 and thromboxane B2 release from human monocytes treated with C3b or bacterial lipopolysaccharide

C3b or lipopolysaccharide treatment of human peripheral blood monocytes in culture stimulates an early release of thromboxane B₂ and a delayed release of prostaglandin E into culture supernatants. Immunoreactive thromboxane B₂ release is maximal from 2–8 h, whereas prostaglandin E release is maximal from 16–24 h after stimulation of monocytes in culture. We further examined this process by comparing the time course of labelled prostaglandin E₂, prostaglandin E₁ and thromboxane B₂ release from human monocytes which were pulse or continuously labelled with [³H]arachidonic acid and [¹⁴C]eicosatrienoic acid. The release of labelled eicosanoids was compared with the release of immunoreactive prostaglandin E and thromboxane B₂. The time course of prostaglandin E₂ release was virtually identical to the release of prostaglandin E₁ in all culture supernatants regardless of labelling conditions. However, release of immunoreactive prostaglandin E paralleled the release of labelled prostaglandin E₁ and E₂ only for continuously labelled cultures. The release of labelled prostaglandin E₁ and E₂ from pulse labelled cultures paralleled the release of thromboxane B₂ and not immunoreactive prostaglandin. In contrast, labelled and immunoreactive thromboxane B₂, quantitated in the same culture supernatants, demonstrated similar release patterns regardless of labelling conditions. These findings indicate that the differential pattern of prostaglandin E and thromboxane B₂ release from human monocytes is not related to a time-dependent shift in the release of prostaglandin E₁ relative to prostaglandin E₂. Because thromboxane B₂ and prostaglandin E₂ are produced through cyclooxygenase mediated conversion of arachidonic acid, these results further suggest that prostaglandin E₂ and thromboxane B₂ are independently metabolized in human monocyte populations.     

hCG-induced prostaglandin E2 and F2 alpha release in adult rat testis: role in Leydig cell desensitization to hCG.

Testicular levels of prostaglandin E₂ and F_2α were measured in decapsulated adult rat testis following hCG stimulation. Basal levels were, respectively, 342 ± 74 and 502 ± 89 pg/testis. Following hCG administration these basal values are not significantly modified up to 2 hours. From 2 to 24 hours the concentrations are clearly increased above the basal level: at 12 hrs they are 1925 ± 165 for E₂ and 3200 ± 190 for F_2α. Levels are back to normal at 48 hrs and remain so until 144 hrs. An identical pattern of prostaglandin release is observed in vitro in Leydig cell preparations isolated at different times following in vivo hCG injection. This suggests that prostaglandins are secreted by Leydig cells. In hypophysectomized animals the release of both prostaglandins E₂ and F_2α is similar to controls indicating that prostaglandin secretion is not directly linked to testosterone production. alternatively testosterone injections (10 mg) does not modify prostaglandin levels. Binding sites for prostaglandins E₁, E₂ and F_2α are present on the Leydig cells and consequently Leydig cell function may be modulated by endogenous or exogenous prostaglandins. Their level is slightly increased at 24 hrs following hCG stimulation. Since the acute changes in prostaglandin E₂ and F_2α secretion occur during the period of “desensitization” and of acute “down regulation” of the LH-hCG receptor in the Leydig cells it is suggested that prostaglandins are involved in both phenomena.     

The interaction of prostaglandins with human serum lipoproteins

Using high density and low density lipoproteins (HDL and LDL) labeled with fluorescent analogues of phosphatidylcholine or sphingomyelin it was found that low amounts (10^–12 M) of prostaglandins E₁ and F₂ induced different structural rearrangements of the lipoprotein surface, whereas prostaglandins E₂ and F₁ had no effect. The effects of prostaglandin E₁ on HDL were largely paralled by those of this prostaglandin on synthetic recombinants prepared from pure apolipoprotein A₁, phospholipids and cholesterol and were demonstrated to be caused by prostaglandin-apolipoprotein interaction. The interaction resembled that of a ligand with a specific receptor protein because it was specific, reversible, concentration and temperature dependent and saturable. However the retaining capacity of HDL or LDL for prostaglandin E₁ as determined by equilibrium dialysis was very low and a single prostaglandin E₁ molecule was able to induce structural changes in large numbers of discrete lipoprotein particles. To explain this remarkable fact a non-equilibrium model of ligand-receptor interaction is proposed. According to that model in open systems characterized by weak ligand-receptor binding, high diffusion rate of the ligand and long relaxation times which exceed the interval between two successive receptor occupations, the ligand-induced changes will accumulate, resulting in transformation of the system into a new state which may be far away from equilibrium. It is emphasized that the low mobility of lipids constituting the environment of the receptor protein plays a critcal role in this type of signal amplification.It was further demonstrated that the PGE₁-induced changes of the lipoprotein surface resulted in an enhancement of LDL-to-HDL transfer of cholesterol esters and phosphatidylcholine especially in the presence of serum lipid transfer proteins. The acceleration of the interlipoprotein transfer caused by prostaglandin E₁ in turn increases the rate of cholesterol esterification in serum. It is suggested that in such a way prostaglandin E₁ may influence the homeostasis of cholesterol.Abbreviations LDL low density lioproteins - HDL high density lipoproteins - PG prostaglandin - ASM anthrylvinyl-labeled sphingomyelin (N-12-(9-anthryl)-11-trans-dodecanoylsphingosin-1-phosphocholine - APC anthrylvinylphosphatidylcholine (1-radyl-2-[(9-anthryl)-11-transdodecanoyl)-sn-glycerophosphocholine - NAP-SM nitroazidophenyl labeled sphingomyelin (N-[N-(2-nitro-4azidophenyl)-12-aminododecanoyl]-sphingosin-1-phosphocholine) - NAP-PC adizophenyl labeled phosphatidylcholine (1-radyl-2-[N-(2-nitro-4azidophenyl)-12-aminododecanoyl]-sn-glycero-3-phosphocholine - DPPC dipalmitoylphosphatidylcholine - P fluorescence polarization - E parameter of tryptophanyl to ASM resonance energy transfer - LEP lipid-exchange protein     

Reduced PGE1 stimulated 3H-cAMP accumulation in platelets from schizophrenics.

Accumulation of ³H-cAMP was measured in platelet rich plasma (PRP) pulse labelled with ³H-adenine and incubated with prostaglandin E₁ (PGE₁). Less PGE₁ stimulated ³H-cAMP accumulation was seen in PRP from schizophrenics than in PRP from controls at all PGE₁ concentrations studied. Levels of ³H-cAMP in PRP incubated without PGE₁ and platelet incorporation of total tritium did not differ between these groups. The possibility that reduced functional prostaglandin activity may be an etiopathologic factor in schizophrenia, and the compatibility of this postulate with diverse theoretical and empirical observations related to schizophrenia are discussed.